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    PSA Pathways BPH

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    Chris French
    The document discusses PSA (prostate-specific antigen) as it relates to benign prostatic hyperplasia (BPH) and prostate cancer. It provides information on PSA's utility as a screening, staging, and post-treatment marker. It describes PSA biology, noting it can be elevated by BPH and inflammation and that a persistent rise may indicate a 40% risk of cancer. Recent prostate cancer screening studies showed similar mortality rates between annual screening and standard care after 7-10 years. Screening benefits must be weighed against overdiagnosis of non-life-threatening cancers. The future of screening may involve individualization, considering PSA patterns not just levels, family history, educating on active surveillance,

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    PSA Pathways BPH

    Uploaded by

    Chris French
    749 views10 pages
    The document discusses PSA (prostate-specific antigen) as it relates to benign prostatic hyperplasia (BPH) and prostate cancer. It provides information on PSA's utility as a screening, staging, and post-treatment marker. It describes PSA biology, noting it can be elevated by BPH and inflammation and that a persistent rise may indicate a 40% risk of cancer. Recent prostate cancer screening studies showed similar mortality rates between annual screening and standard care after 7-10 years. Screening benefits must be weighed against overdiagnosis of non-life-threatening cancers. The future of screening may involve individualization, considering PSA patterns not just levels, family history, educating on active surveillance,

    Original Description:

    PSA patterns and a BPH related case commonly seen in clinical practice

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    The document discusses PSA (prostate-specific antigen) as it relates to benign prostatic hyperplasia (BPH) and prostate cancer. It provides information on PSA's utility as a screening, staging, and post-treatment marker. It describes PSA biology, noting it can be elevated by BPH and inflammation and that a persistent rise may indicate a 40% risk of cancer. Recent prostate cancer screening studies showed similar mortality rates between annual screening and standard care after 7-10 years. Screening benefits must be weighed against overdiagnosis of non-life-threatening cancers. The future of screening may involve individualization, considering PSA patterns not just levels, family history, educating on active surveillance,

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    749 views10 pages

    PSA Pathways BPH

    Uploaded by

    Chris French
    The document discusses PSA (prostate-specific antigen) as it relates to benign prostatic hyperplasia (BPH) and prostate cancer. It provides information on PSA's utility as a screening, staging, and post-treatment marker. It describes PSA biology, noting it can be elevated by BPH and inflammation and that a persistent rise may indicate a 40% risk of cancer. Recent prostate cancer screening studies showed similar mortality rates between annual screening and standard care after 7-10 years. Screening benefits must be weighed against overdiagnosis of non-life-threatening cancers. The future of screening may involve individualization, considering PSA patterns not just levels, family history, educating on active surveillance,

    Copyright:

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    of 10

    PSA Pathways

    BPH and Prostate Cancer


    Christopher French MD FRCSC

    Tuesday, January 19, 2010


    PSA Utility

    • A Screening Tool

    • A Staging Tool

    • A Post Treatment
    Marker

    Tuesday, January 19, 2010


    PSA Biology
    • A surrogate for benign enlargement

    • Spike rises and falls in inflammation/


    BPH

    • A persistent rise above age adjusted


    limits ,not explained by a pattern of BPH,
    is associated with a 40% risk of cancer.

    • High grade cancers (gleason 9 or 10) are


    typically not represented in the PSA level.

    Tuesday, January 19, 2010


    PSA Biology

    Tuesday, January 19, 2010


    BPH

    Gleason 3+3
    Prostate
    Cancer

    Prostate Histology
    Tuesday, January 19, 2010
    Recent Screening
    Studies
    • PLCO

    • Annual Screening vs Current Standard

    • After 7-10 years the mortality rates were


    similar

    • ERSPC

    • Annual Screening vs unscreened control

    • 20% reduction in prostate cancer mortality

    Tuesday, January 19, 2010


    Mortality Benefits of
    Screening

    • Benefits of
    screening have to
    weighed against a
    potential 50%
    incidence of non life
    threatening cancers.

    Tuesday, January 19, 2010


    Prostate Cancer
    screening future

    • Individualize the screening process

    • Consider PSA patterns not single PSA

    • Family history

    • Educate on the safety of Active Surveillance

    • Implement tools to complement PSA

    • Chemoprevention

    Tuesday, January 19, 2010


    PSA Case 1

    Assumes a 15 year life


    expectancy
    BPH symptoms predominate
    • 61 yo man with visit
    Screening data suggest to
    moderate rule out cancer

    obstructive
    symptoms and PSA
    4.5 Benign feeling
    55gm prostate.
    Healthy otherwise

    Tuesday, January 19, 2010


    Management Priority
    • Clinical BPH OK, Repeat PSA is 2.3----BPH

    What if it came back at 4.8 and 5.0?


    • Confirm with PSA pattern
    Patient wants to see a urologist, who repeats PSA and
    • Biopsy? it’s 5.0
    Biopsy shows BPH in 12 Cores, suggests alpha Blocker
    and a follow up with Uroflow and PSA in 1 year

    • If Family History, or PSA pattern

    • Alpha Blocker Before he see’s the Urologist patient says that he


    is no better. Wants PSA checked sooner. Change
    Alpha blocker? Add 5ARI?
    • Symptom Control
    What if I said there is a tablet that can shrink
    • What about 5ARI? your prostate by 30%, decrease your risk of BPH
    surgery and reduce your risk of prostate cancer
    by 25%. OK, at what cost Doc?

    • Failure of Alpha Blocker, chemoprevention?


    Tuesday, January 19, 2010

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